P0527 - Comparing and Contrasting Outlet Dysfunction and Slow Transit Constipation: Results From a Global Healthcare Database Study

Benjamin D. Liu, MD¹, Ronnie Fass, MD², Gengqing Song, MD², Michael Kurin, MD^1
1MetroHealth, Cleveland, OH; ²MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH

Introduction: Chronic constipation can occur due to outlet disorders (ODC) or slow transit (STC). We characterized and compared these patient populations in terms of demographics, comorbidities, risk factors, management, and outcomes using a global healthcare database.

Methods: Three study cohorts were constructed on the TriNetX platform based on ICD-10 coding 1) ODC; K59.02 or 2) STC; K59.01 3) Both STC and ODC (BOTH). Patients with potential secondary causes of constipation were excluded. Key clinical and demographic characteristics were extracted, and compared using chi-square testing with Bonferroni correction. Propensity-score 1:1 matching was performed for 3 pairwise analyses. Odds ratios for treatments and relevant outcomes within 3 years of initial constipation diagnosis were reported.

Results: Half of BOTH patients underwent anorectal manometry compared to 32% in ODC and a mere 1% in STC. “Smart pill” usage was low in all cohorts. Despite higher odds of biofeedback training in BOTH, the completion rates remained low across cohorts. The BOTH cohort had significantly higher proportions of female and white patients, as well as patients with psychiatric comorbidities, opioid exposure, disorders of gut-brain interaction (DGBI), fibromyalgia, migraines, or interstitial cystitis. STC patients were more exposed to constipating medications compared to ODC. Secretagogue usage was low in matched STC cohorts (7%) compared to BOTH (OR 4.49; 95% CI 3.65 – 5.51) and ODC (OR 2.46; 95% CI 2.08 – 2.91). Prokinetic usage was low in all groups, particularly in STC (1%). Fecal incontinence was reported in 18% of ODC and BOTH patients, compared to 3% in STC. BOTH patients were less likely to be hospitalized (OR 0.80; 95% CI 0.67 – 0.95) or visit the emergency room (OR 0.68; 95% CI 0.58 – 0.79) following their first constipation diagnosis compared to STC.

Discussion: There is an evident disparity in the diagnostic workup and management of constipation subtypes, especially in the STC group. This STC group is less likely to be evaluated with anorectal manometry or be treated with secretagogues or prokinetics, yet have higher healthcare utilization, even in the presence of more comorbid DGBIs and associated conditions compared to other cohorts. An appropriate increase in referrals for anorectal manometry and biofeedback therapy may improve outcomes and allow for more personalized management.




Disclosures:


Benjamin D. Liu, MD¹, Ronnie Fass, MD², Gengqing Song, MD², Michael Kurin, MD¹. P0527 - Comparing and Contrasting Outlet Dysfunction and Slow Transit Constipation: Results From a Global Healthcare Database Study, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.